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Liesel Hlista

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<html>
  <body>
    <form-template>&#13;
	<fields><field type="text" subtype="text" required="true" label="First name" className="form-control" name="first-name"></field><field type="text" subtype="text" required="true" label="Last name" className="form-control" name="last-name"></field><field type="text" subtype="text" required="true" label="Email" className="form-control" name="email"></field>&#13;
		<field type="header" subtype="h2" label="Questions for your trip"/>&#13;
		<field type="text" label="Where would you like to go ? &amp;nbsp;Is there more than one location?" description="If you&#39;re not sure  just give me a few destinations you&#39;re considering." name="destination" subtype="text" className="form-control"/>&#13;
		<field type="date" label="When would you like to depart?" description="This just gives me a general idea of when you like to go; it can be changed later." name="starting-at" className="form-control"/>&#13;
		<field type="date" label="When would you like to return?" description="This just gives me a general idea of when you like to return; it can be changed later." name="ending-at" className="form-control"/>&#13;
		<field type="checkbox-group" label="Are your dates flexible?" name="dates-flexible">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
		</field>&#13;
		<field type="text" label="What is your departure city? And will you need flights?" description="Where will you be flying from?" name="departure-city" subtype="text" className="form-control"/>&#13;
		<field type="text" label="How many travelers? And what are their ages?" name="number-of-travelers" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" label="What would you like to spend on accommodations per night?" description="This just gives me a general starting point and can always be changed later." name="budget">&#13;
			<option label="$400-500" value="400500">$400-500</option>&#13;
			<option label="$500-$750" value="500750">$500-$750</option>&#13;
			<option label="$750-$1000" value="7501000">$750-$1000</option>&#13;
			<option label="$1000-$1200" value="10001200">$1000-$1200</option>&#13;
			<option label="$1200-$1500" value="12001500">$1200-$1500</option>&#13;
			<option label="$1500-$2000" value="15002000">$1500-$2000</option>&#13;
			<option label="not worried about budget of this trip" value="not-worried-about-budget-of-this-trip">not worried about budget of this trip</option>&#13;
		</field>&#13;
		<field type="radio-group" label="What best describes your hotel preference?" name="hotel-preference" other="true">&#13;
			<option label="Economy" value="value">Economy</option>&#13;
			<option label="Moderate" value="moderate">Moderate</option>&#13;
			<option label="Boutique" value="boutique">Boutique</option>&#13;
			<option label="Luxury" value="luxury">Luxury</option>&#13;
			<option label="Ultra Luxe" value="ultra-luxe">Ultra Luxe</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="What kind of vibe are you looking for?" description="Check all that apply." name="vibe-preference" other="true">&#13;
			<option label="Romantic" value="romantic">Romantic</option>&#13;
			<option label="Rest and relaxation" value="rest-and-relaxation">Rest and relaxation</option>&#13;
			<option label="Off the beaten path" value="off-the-beaten-path">Off the beaten path</option>&#13;
			<option label="Celebration" value="celebration">Celebration</option>&#13;
			<option label="Local culture" value="local-culture">Local culture</option>&#13;
			<option label="Family friendly" value="family-friendly">Family friendly</option>&#13;
			<option label="Food and wine" value="food-wine">Food and wine</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="What activities are you interested in?" description="Check all that apply" name="activity-preferences" other="true">&#13;
			<option label="Beach and water" value="beach-water">Beach and water</option>&#13;
			<option label="Adventure activities" value="adventure">Adventure activities</option>&#13;
			<option label="Golf" value="golf">Golf</option>&#13;
			<option label="Nightlife" value="nightlife">Nightlife</option>&#13;
			<option label="Arts &amp; Theater" value="arts-theater">Arts &amp; Theater</option>&#13;
			<option label="Food " value="food-">Food </option>&#13;
			<option label="Wine " value="wine-">Wine </option>&#13;
			<option label="History &amp; Culture" value="history-culture">History &amp; Culture</option>&#13;
		</field>&#13;
		<field type="text" label="What is most important for this vacation? And what else would you like me to know?&amp;nbsp;" name="must-dos" subtype="text" className="form-control"/>&#13;
		<field type="textarea" label="&amp;nbsp;Can you share a favorite travel experience/hotel you have loved? This allows me to get an idea of your travel preferences.&amp;nbsp;" name="notes" className="form-control"/>&#13;
		<field type="text" label="How did you hear about Glow Escapes? And which designer are you interested in working with Liesel Hlista or Aimee Dunford?" name="text-1771456040072" subtype="text" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>